Figures
- FIGURE 1
Chest computed tomography image of a patient with diffuse alveolar haemorrhage showing bilateral consolidative and ground-glass changes.
- FIGURE 2
High-resolution chest computed tomography image of a patient with bronchiolitis obliterans syndrome showing mosaic pattern.
- FIGURE 3
Chest computed tomography image of a patient with pulmonary fibrosis and air leak syndrome.
- FIGURE 4
Algorithm of the initial diagnostic approach to haematopoietic stem cell transplantation (HSCT) patients presenting with new respiratory symptoms. HRCT: high-resolution computed tomography; BAL: bronchoalveolar lavage; PERDS: peri-engraftment respiratory distress syndrome; DAH: diffuse alveolar haemorrhage; COP: cryptogenic organising pneumonia; AIP: acute interstitial pneumonitis; ARDS: acute respiratory distress syndrome; PFT: pulmonary function test. #: spirometry showing forced expiratory volume/forced vital capacity <0.7 and decrease in forced expiratory volume in 1 s ≥10% from baseline. ¶: decline in total lung capacity ≥10% from baseline. +: persistent multilobar opacities (ground-glass, consolidation, small linear and reticular) with increasing pleural thickening consistent with pulmonary and/or pleural fibrosis.
Tables
- TABLE 1
Diagnostic criteria of idiopathic pneumonia syndrome following haematopoietic stem cell transplantation
Evidence of widespread alveolar injury:
Multilobar infiltrates on chest imaging
Symptoms and signs of pneumonia
Increased A–a gradient, restrictive pattern on pulmonary function test
Absence of LRT infection after appropriate evaluation:
Bronchoalveolar lavage negative for bacterial and nonbacterial pathogens
Serological studies negative for viral and fungal infections
Lung biopsy if patient's condition permits and above work-up is inconclusive
Absence of cardiac dysfunction, acute renal failure or iatrogenic fluid overload as aetiology for pulmonary dysfunction
- TABLE 2
Clinical spectrum of idiopathic pneumonia syndrome following haematopoietic stem cell transplantation as categorised by presumed site of primary tissue injury
Pulmonary parenchyma Vascular endothelium Airway epithelium Acute interstitial pneumonitis Peri-engraftment respiratory distress syndrome Cryptogenic organising pneumonia Acute respiratory distress syndrome Diffuse alveolar haemorrhage Delayed pulmonary toxicity syndrome - TABLE 3
Diagnostic criteria of bronchiolitis obliterans syndrome following haematopoietic stem cell transplantation
FEV1/FVC ≤0.7
FEV1≤75% of predicted with at least 10% decline from baseline, no significant post-bronchodilator response
Additional evidence of small-airway disease (at least 1 out of 3)
Evidence of air trapping, small-airway thickening or bronchiectasis on high-resolution computed tomography of chest (with inspiratory and expiratory cuts)
Residual volume 120%, or elevated residual volume/total lung capacity
Pathologic confirmation of constrictive bronchiolitis
Absence of infection in the respiratory tract
By appropriate clinical, radiologic, microbiologic studies (sinus aspiration, upper respiratory tract, viral screen, sputum culture or bronchoalveolar lavage)
FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity.
Jump To
- Article
- Abstract
- Abstract
- Introduction
- Idiopathic pneumonia syndrome
- Peri-engraftment respiratory distress syndrome
- Diffuse alveolar haemorrhage
- Cryptogenic organising pneumonia
- Bronchiolitis obliterans syndrome
- Interstitial lung disease
- Pleural effusions
- Thoracic air leak syndrome
- Venous thromboembolic disease
- Pulmonary hypertension
- Post-transplant lymphoproliferative disorder
- Diagnostic considerations of noninfectious pulmonary complications following HSCT
- Conclusion
- Footnotes
- References
- Figures & Data
- Info & Metrics